胆道外科手术中及术后发现肝吸虫病15例临床分析

亓文磊; 张若岩; 柴文刚; 柳明江; 杜晓宏; 叶军锋

doi:10.3969/j.issn.1001-5256.2016.11.026

胆道外科手术中及术后发现肝吸虫病15例临床分析

DOI: 10.3969/j.issn.1001-5256.2016.11.026

吉林大学白求恩第一医院肝胆胰外一科

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中图分类号: R657.4
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出版历程
- 出版日期: 2016-11-20

Diagnosis of clonorchiasis during and after biliary tract surgery: a clinical analysis of 15 cases

摘要

摘要: 目的分析胆道外科手术过程中发现肝吸虫病的临床特点,为肝吸虫病的外科治疗提供更全面、有效的诊疗信息。方法回顾性分析吉林大学白求恩第一医院肝胆胰外科2013年1月-2016年1月胆道手术中及术后发现的15例肝吸虫病患者临床资料,总结其临床特点。结果 15例患者全部为男性,其中5例患者明确曾生食淡水鱼虾,8例行腹腔镜胆道探查术,7例行经内镜逆行胰胆管造影（ERCP）,均于术中或术后引流液中发现成虫。15例患者规律驱虫治疗后治愈。结论胆道探查术中发现灰黑色或鲜红色瓜子样絮状物,应高度怀疑肝吸虫,并建议术中留置T管引流;腹腔镜胆道探查术T管引流术后或ERCP鼻胆管引流术后发现可疑肝吸虫,需进一步行微生物学检查;已经明确的肝吸虫病,需杜绝生食鱼虾并行规律的驱虫治疗。
- 片形吸虫,肝 /
- 胆总管结石 /
- 胆道外科手术
Abstract: Objective To investigate the clinical features of clonorchiasis diagnosed during biliary surgery,and to provide more comprehensive and effective information for the surgical treatment of clonorchiasis. Methods A retrospective analysis was performed for the clinical data of 15 patients who were diagnosed with clonorchiasis during and after biliary tract surgery in our department from January 2013 to January 2016,and their clinical features were summarized. Results All the 15 patients were male,among whom 5 once ate uncooked freshwater fish and shrimps. Of all patients,8 underwent laparoscopic bile duct exploration and 7 underwent endoscopic retrograde cholangiopancreatography( ERCP). Adult Clonorchis sinensis was found in intraoperative or postoperative drainage. All the patients achieved clearance of Clonorchis sinensis after regular anthelmintic treatment. Conclusion If bile duct exploration finds grey- black or bright- red melon seed-like floccules,clonorchiasis should be highly suspected. Intraoperative T- tube drainage is recommended,and if suspected Clonorchis sinensis is found after laparoscopic bile duct exploration and T- tube drainage or after ERCP and nasobiliary drainage,microbiological examination should be performed next. As for the patients with a definite diagnosis of clonorchiasis,they should not eat uncooked freshwater fish or shrimps and should be given regular anthelmintic treatment.
- fasciola,hepatica /
- choledocholithiasis /
- biliary tract surgical procedures

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参考文献(16)

[1]FANG YY,CHEN YD,LI XM,et al.Current prevalence of clonorchis sinensis infectionin endemic areas of China[J].Chin J Parasitol Parasitic Dis,2008,26(2):99-103.(in Chinese)方悦怡,陈颖丹,黎学铭,等.我国华支睾吸虫病流行区感染现状调查[J].中国寄生虫学与寄生虫病杂志,2008,26(2):99-103.

[2]LUN ZR,GASSER RB,LAI DH,et al.Clonorchiasis:a key foodborne zoonosis in China[J].Lancet Infect Dis,2005,5(1):31-41.

[3]CHEN XB,WU GL.Modern Parasitology[M].Beijing:People’s Military Medical Press,2002:571-589.(in Chinese)陈兴保,吴观陵.现代寄生虫病学[M].北京:人民军医出版社,2002:571-589.

[4]LEI CH,ZHANG DQ,LIU M,et al.A case of cholangitis associated with liver fluke infection[J].Trauma and crit Medicine,2015,3(6):369-370.(in Chinese)雷春红,张东琪,刘梦,等.肝吸虫性胆管炎17例[J].创伤与急危重病医学,2015,3(6):369-370.

[5]CHOI BI,HAN JK,HONG ST,et al.Clonorchiasis and cholangiocarcinoma:etiologic relationship and imaging diagnosis[J].Clin Microbiol Rev,2004,17(3):540-552.

[6]WATANAPA P,WATANAPA WB.Liver fluke-associated cholangiocarcinoma[J].Br J Surg,2002,89(8):962-970.

[7]MA RH,QIAO T,LUO ZL,et al.Gallbladder stone types in patients with cholelithiasis and clonorchissinensis infection in the endemic area of clonorchiasis[J].Chin J Parasitol Parasitic Dis,2015,33(3):167-171.(in Chinese)马瑞红,乔铁,罗振亮,等.华支睾吸虫病流行区胆石症患者胆囊结石类型及华支睾吸虫感染情况[J].中国寄生虫学与寄生虫病杂志,2015,33(3):167-171.

[8]MACHICADO C,MARCOS LA.Carcinogenesis associated with parasites other than Schistosoma,Opisthorchis and Clonorchis:a systematic review[J].Int J Cancer,2016,138(12):2915-2921.

[9]HAO YH,LI YX,SUN QS,et al.Research advances in pathogenesis of cholangiocarcinoma caused by Clonorchis sinensis infection[J].Chin J Infect Dis,2014,32(11):702-704.(in Chinese)郝玉花,李玉香,孙青松,等.华支睾吸虫感染致胆管癌机制的研究进展[J].中华传染病杂志,2014,32(11):702-704.

[10]LIANG ZC,QIU SZ,LUO LX.Discussion on relationship between hepatobiliary pathological changes under B-ultrasound and Clonorchis sinensis infection[J].Chin J Schistosomiasis Control,2015,27(6):631-633.(in Chinese)梁致成,邱守中,罗立旋.肝胆B超病理改变与华支睾吸虫感染的相关性探讨[J].中国血吸虫病防治杂志,2015,27(6):631-633.

[11]JI X,LUO J,XU CF,et al.The study of multi-slice spiral CT manifestations of hepatic clonorchiasis[J].J Med Imaging,2014,24(6):977-979.(in Chinese)纪祥,罗军,徐翠芳,等.肝华支睾吸虫病多层螺旋CT表现的研究[J].医学影像学杂志,2014,24(6):977-979.

[12]JIAN X,HUO F,WANG SP,et al.Clinical features and treatment of Clonorchis sinensis cholangitis[J].J Hepatopancreatobiliary Surg,2008,21(3):217-218.(in Chinese)建雄,霍枫,汪邵平,等.华支睾吸虫性胆管炎的临床特点及治疗[J].肝胆胰外科杂志,2008,21(3):217-218.

[13]ZHOU M,WANG Y.Role of ultrasound and magnetic resonance cholangiopancreatography in diagnosis of Clonorchis sinensis cholangitis:a comparative study[J].Chin Community Doct,2012,14(16):253-254.(in Chinese)周敏,王岩.超声及MRCP诊断华支睾吸虫性胆管炎的对比研究[J].中国社区医师:医学专业,2012,14(16):253-254.

[14]HONG ST,FANG Y.Clonorchis sinensis,and clonorchiasis,an update[J].Parasitol Int,2012,61(1):17-24.

[15] ZHU HL.Clinical effect of praziquantel in treatment of clonorchiosis[J].Clin Res,2016,24(1):65.(in Chinese)朱华利.吡喹酮治疗华支睾吸虫病的临床疗效[J].临床研究,2016,24(1):65.

[16]XU LL,JIANG B,ZHOU XN.Advances on the drugs development against Clonorchis sinensis[J].Int J Med Parasit Dis,2013,40(4):212-215.(in Chinese)徐莉莉,姜斌,周晓农.抗华支睾吸虫药物研究进展[J].国际医学寄生虫病杂志,2013,40(4):212-215.

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